When it hurts to help; Professor wants more workplace safety training to prevent gun violence for nurses

(Ball State Daily News) Nursing programs around the nation are missing a key component, according to a study done by a professor who advocates for stronger programs on safety and gun violence.

For assistant professor JagdishKhubchandani, the issue hit home when a colleague was shot by her patient. He and the woman were planning to conduct a study together on gun violence against nurses.

“Unfortunately, she is no more now,”Khubchandani said. “She was shot by a patient, who was so psychotic he killed the best physician he ever got.”

The community health education instructor has helped conduct seven studies in the past five years, including one recently published that reveals what he thinks is a failure in nursing education.

UNPREDICTABLE SITUATIONS

Violence that occurs in a nurse’s workplace isn’t limited to whatKhubchandani’s colleague experienced and what is most often publicized: that a patient is being aggressive toward a medical professional.

Assistant nursing professor Cindy Thomas said the most common form of violence currently seen in health care occurs between nurses. She said violence between physicians and nurses is second, and violence between patients and nurses is actually third most common.

At the senior undergraduate level, Ball State teaches its nursing students how to prevent, recognize, diffuse and report violence in the workplace. Thomas said her Nursing 425 course on leadership management gives students the skills they will need to handle the often unpredictable situations they might face after graduation.

“Violence isn’t just related to firearms,” Thomas said. “It can be throwing a patient chart, for instance, yelling at a nurse or patient, or nonverbal issues such as not responding when someone asks a question, rolling your eyes or just walking away. All of these are considered violent behaviors and nurses have to know how to deal with them.”

Sophomore Winnie Njagi is a nursing major who has worked for four years at a group home for people who are mentally ill. She said she has many positive stories about her experiences but there are times when the job can be almost unbearably stressful.

“I used to work with this lady who had severe bipolar disorder and depression,” Njagi said. “She would have episodes where she’d want to kill herself or would start tearing her room up. She’d come at you and try to hit you. [One time] she hit me, and I wasn’t even prepared … I think I have a mark on my back.”

RESEARCH AND FINDINGS

Khubchandani said he hopes his research will convince nursing program directors and others of the seriousness of the problem.

“People say prevention is key, but every year, 30,000 people lose their lives to firearms,” Khubchandani said. “We have no funding for research and development, there is no prevention effort, and most of my studies are out of pocket from my own paycheck.”

His most recent study, which he said he estimates cost him $3,000, assesses how well psychiatric nurses in graduate school programs are trained in preventing injuries caused by guns. He said he found weak results.

Only four of the 64 respondents, directors of graduate school psychiatric nursing programs in the U.S., said they had received training on firearm safety. Only 9 percent of directors were actively training their students about preventing gun trauma; 87 percent hadn’t even thought about it.

“I fail to understand [how this can be],” Khubchandani said. “The group of professionals who are most likely to be shot by their clients is psychiatrists. All this needs is a three-hour training [session].”

The American Medical Association has publications advocating for the control and limitation of access to firearms. The American Psychiatric Nurses Association’s task force on workplace violence issued a position statement in 2008 that stated individual nurses should be able to recognize hints that patients could become violent and nursing educators “must include workplace violence prevention … in the curriculum.”

It’s clear that the directors in Khubchandani’s study believe their nurses make an impact on their patients — only one respondent said psychiatric nurses could not affect their patients’ gun behavior through counseling. But it appears that the directors are still hesitant to implement training.

Nearly 50 percent of respondents said they weren’t sure if their students’ patients would accept firearm safety guidance and 40 percent weren’t sure if the patients would consider psychiatric nurses qualified to give it.

“Some of the directors are in small places, happy towns, and they haven’t seen a lot of violence,” Khubchandani said. “They don’t realize their graduating students could go anywhere. If I graduate a student in Muncie and think violence is not a big issue, I fail to realize the student could go to downtown Chicago and see a lot of violence.”

SPEAKING FROM EXPERIENCE

At the group home where Njagi worked, she said the employees who work with the residents aren’t all psychiatric nurses and only a high school diploma and interview were required for her to get the job.

A typical 12-hour shift for Njagi varied according to the needs of the patients she worked with, but usually included waking the patient, helping them at mealtime, supervising their way to the bathroom, giving them medication, possibly accompanying them on a group outing and supervising them during free time.

Njagi said some patients at the home are diagnosed with borderline personality disorder, bipolar disorder, schizophrenia, severe depression, autism or other more rare conditions.

The home’s employees are taught how to restrain patients without harming them or allowing them to harm themselves, but Njagi said occasional extreme situations necessitated calling the police.

“They get so strong, and you can’t safely restrain them,” Njagi said. “We’ve had other incidents where we’re just sitting down, thinking everything’s fine, and then [a patient] will come up and punch you in the face.”

Those who battle with these types of mental illnesses are prohibited by law from purchasing firearms, and the home at which Njagi works keeps anything that could potentially function as a weapon under lock and key.

“These are people who have no control over the way they act or the way they think,” Njagi said. “Somebody like that, who can just do a random act, you can not trust them with a weapon. People feel like we’re discriminating against them, but their brain function is not normal.”